| R. Shane Roberts, M.d., Inc. | |
|
398 N Main St Decatur TN 37322-7759 | |
| (423) 334-2222 | |
| (423) 334-2255 |
| Full Name | R. Shane Roberts, M.d., Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 398 N Main St, Decatur, Tennessee |
| Authorized Official Name and Position | R. Shane Roberts (OWNER) |
| Authorized Official Contact | 4233342222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| R. Shane Roberts, M.d., Inc. 398 N Main St Decatur TN 37322-7759 Ph: (423) 334-2222 | R. Shane Roberts, M.d., Inc. 398 N Main St Decatur TN 37322-7759 Ph: (423) 334-2222 |
| NPI Number | 1508062977 |
|---|---|
| Provider Enumeration Date | 06/22/2007 |
| Last Update Date | 03/10/2022 |
| Medicare PECOS PAC ID | 9436060258 |
|---|---|
| Medicare Enrollment ID | O20030724000030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508062977 | NPI | - | NPPES |
| 0443935 | Medicaid | TN | |
| 3718733 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 024022 (Tennessee) | Primary |
Restoration Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16850 State Highway 58 South, Suite A, Decatur, TN 37322 Phone: 423-506-3781 Fax: 423-454-0125 | |
R. Shane Roberts, M.d., Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 398 N Main St, Decatur, TN 37322 Phone: 423-334-2222 Fax: 423-334-2255 | |
Ocoee Regional Health Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 305 River Rd, Decatur, TN 37322 Phone: 423-334-4154 Fax: 423-334-4195 |